As if arthritis pain weren’t enough to deal with on its own, a new study finds that one-third of American adults with arthritis also suffer from anxiety or depression.

Arthritis affects an estimated 50 million Americans and is the number one cause of disability worldwide, according to researchers from the Centers for Disease Control and Prevention (CDC). Both depression and anxiety are common among people suffering from chronic disease, but while physicians know to look for signs of depression, they often fail to consider anxiety.

The new CDC study suggests that doctors pay more attention to anxiety symptoms, since they are actually twice as common in arthritis patients compared with depression.

The researchers surveyed 1,793 adults 45 years or older with doctor-diagnosed arthritis or other rheumatic conditions, who responded to a previous CDC Arthritis Conditions and Health Effects Survey. The team assessed the participants’ anxiety and depression based on their responses to emotional well-being questions from the Arthritis Impact Measurement Scales, such as: “During the past 12 months, have you sought help for stress, depression or problems with emotions?”

The researchers found that one-third of the survey participants reported having either anxiety or depression, and that 84% of the patients with depression also had anxiety. On average, 31% of the participants had anxiety and 18% had depression.

“People with arthritis face a lot of challenges associated with the physical symptoms. If you’re worried about your livelihood and your ability to perform at your job, this can be very stressful,” says lead researcher Dr. Louise Murphy with the Arthritis Program at the CDC in Atlanta, Ga.

What was even more concerning was that only half of the study participants who had anxiety or depression had sought mental health care for their symptoms.

“When we looked at the characteristics of the people with anxiety, there was not a specific group that popped out which suggested that all people with arthritis have a risk of anxiety and depression,” says Murphy. “Knowing the significant complications they can create shows there is a need to address anxiety and depression on a wider scale.”

Since so many arthritis patients are not seeking mental health treatment, physicians are missing opportunities to intervene and improve patients’ quality of life, says Murphy. Pain, disability, anxiety and depression can become part of a vicious “symptom cycle,” and breaking that cycle can provide both physical and psychological relief.

“If health care providers can start screening people with arthritis for anxiety and depression, they can interrupt this cycle by treating the emotional aspects of the disease, which will allow them to better treat the physical aspects,” says Murphy.

The CDC also encourages patients to share in their treatment by enrolling in programs for exercise and stress management. “Physical activity has strong health benefits and these programs can help people with anxious about exercise,” says Murphy.

“Everyone has a role in addressing this problem,” says Murphy. “Overall this study shows we need to start taking a broader approach in dealing with arthritis and addressing the mental health symptoms and not just the physical symptoms.”

The study was published in the April 30 issue of the American College of Rheumatology’s journal Arthritis Care & Research.